Patients-in-waiting

Whenever I talk to people around the country about the health care system and what they think of our doctors, one of the chief complaints I receive is that of the long hours spent waiting to see the physician despite their clearly stated clinic hours. With the doctor arriving late and so many patients waiting, “we ended up seeing the doctor only after X number of hours and even then, the whole consult lasted just a few minutes,” people tell me.

As a medical doctor myself (albeit a nonpracticing one), I know enough of the medical profession to see what’s happening from the doctor’s perspective. There may be set clinic hours, but owing to the overall range of activities doctors in the Philippines are expected to fulfill—e.g., clinic and hospital rounds and sometimes admin work, teaching, and so on—they end up lagging behind their schedule. Often, doctors cover multiple clinics on the same day, some because of the sheer lack of specialists in their area, others because of the felt need to earn more (contrary to common perception, being a medical doctor is not a guarantee of wealth; one has to work more to earn more). Still, patients are on the receiving end of this poor state of affairs—and its normalization over decades does not make it any more acceptable. What can we do about this?

Several years ago, I was sent by the Asian Development Bank on an assignment to Singapore and South Korea to find out the best practices of innovative hospitals. In one hospital in Singapore, patients are offered two choices before they are seen by the doctor: either they wait in a very convenient room, complete with sofa chairs, electric sockets, high-speed Wi-Fi, and large TV screens. Or they are handed a pager like those in restaurants that buzz when it’s time for them to go back to the clinic; in the meantime, they can roam around in the nearby gardens or even the adjacent mall. It may be unrealistic to expect such solutions to be applied carte blanche in the Philippines, especially for small clinics, but by simply recognizing waiting time as a problem, we can come up with solutions that range from picking low-hanging fruit to uprooting physician-centered structures of power.

From the technology side, patients can be managed in terms of low-cost digital services, like text or Viber messages—which is what many doctors and their secretaries are already doing with patients, especially in smaller cities and towns—though we should be directing more thought on how to optimize and make them accessible to the poor.

If the waiting time cannot be reduced, it can, as in Singapore, be made more comfortable. Free Wi-Fi, comfortable chairs, good air conditioning, books and magazines to read—e.g., Luis Gatmaitan’s award-winning biology-oriented stories for children, as well as our growing body of medical humanities publications—are among the improvements that go a long way. While some of these amenities already exist in some hospitals and clinics, the challenge is to make them more widely accessible.

Another response can come from medical education. Most medical schools have some kind of management and “art of medicine” courses, which can be venues to think not just about patient care, but using design and technology to improve services. Perhaps doctors’ secretaries—often informally cast in the health care sector—can also receive some kind of professional development training?

Of course, some of the waiting also has to do with overall infrastructure, with doctors and patients alike being delayed because of traffic even in small and medium-sized cities. Moreover, as I hinted above, there are also structural issues that have to do with the number, distribution, and specialization of doctors in the country, and it remains a question whether the nascent universal health care scheme can make a difference. Hospitals and individual medical doctors in the Philippines are working on this on different levels. For instance, Dr. Vicente Bernardo, an ophthalmologist at Dagupan Doctors Villaflor Memorial Hospital, says they are thinking about patients’ entire therapeutic itineraries: “To improve overall patient convenience, we pushed for integration of selected services, like establishing a diabetes center, which effectively streamlined referrals and multidisciplinary care, while allowing patients less waiting time and faster overall management.”

For his part, Dr. Arnaldo Favila, an orthopedic surgeon in Puerto Princesa, tells me that good old professionalism matters. “I try my best to arrive on time for my patients,” he tells me. “I try to conduct a good and concise history and [physical examination]. And I make sure that they will not feel I am rushing them during the consultation, that they would leave my clinic fully understanding the disease and treatment options.”

Such steps are very welcome because they signal respect not only for our patients’ time, but also their dignity.

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